Post-Extraction Concerns After Upper Right Second Molar Surgery

Issues After Extraction of the Upper Right Second Molar

Hello, Dr.
Huang! I finally managed to get an appointment at a major hospital's oral surgery department (the clinic referred me).
Three days ago, I underwent surgery to remove the upper right second molar, which had a root canal treatment and a crown placed thirty years ago (the crown broke, but there was no pain, and the doctor said there was no inflammation).
The surgery lasted about an hour, with an additional dose of anesthesia.
During the procedure, I felt a dull pain (pressure and pulling) in the right wing of my nose, which the doctor thought was caused by his hand pressing against it.
After the surgery, there was minimal bleeding, and the doctor mentioned that my tooth root was very stable and difficult to extract.
I was instructed to bite down on gauze for 20 minutes before removing it, and to return if I experienced fluid leaking from my nostrils when drinking water.
I was prescribed medication for three days.
I bit down on the gauze for nearly three hours until I took my medication at noon.
When I removed the gauze, I felt a strong pressure and airflow in my oral and nasal cavities (sinus cavity?), and even my ears felt pressure.
I almost choked while swallowing the medication; it was difficult to swallow, and there seemed to be a force affecting the flow of liquids.
The pain in my right nostril was noticeable, and there was swelling and pain in my right neck and jaw area, with a temperature of 37.8°C.
However, after taking the anti-inflammatory and pain medication, the discomfort became less pronounced.
That evening, I noticed dried blood in my right nostril.
The next day, I felt less pain during the day, but by the evening until the morning of the third day (before taking my last dose of medication), I experienced significant pain in my neck and gums (even in both upper and lower gums), radiating to my shoulders; I also noticed a loud sound coming from my gums (not vocal cord sounds).
My temperature was 37.6°C.
Since it was already Friday, the dental staff at the hospital said there were no appointments in the afternoon, and advised that if I couldn't tolerate the pain, I should return.
They also mentioned that for neck pain, I should see an ENT specialist, stating there was no infection.
May I ask if, as the hospital staff indicated, I should just endure it for a week and it should heal? Is it correct that I don't need to continue medication after three days? Are the symptoms I described expected by the doctor, or are they abnormal? Thank you for your clarification and advice!

Hsieh, 50~59 year old female. Ask Date: 2018/07/20

Dr. Huang Tingfang reply Dentistry

Dear Ms.
Hsieh,
Hello! As mentioned, there is a possibility that extracting the upper right second molar may affect the sinus membrane (the roots of the upper posterior teeth often extend into the sinus).
As long as you avoid vigorous exercise within one week after the extraction, you should see improvement! Tooth extraction is considered a minor surgical procedure, so it is important to maintain oral hygiene within that week to prevent infection; also, avoid catching a cold, and your symptoms should improve quickly! Please communicate frequently with your physician.
Thank you! Wishing you safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2018/07/20

More Info

After undergoing the extraction of your upper right second molar, it is understandable to have concerns regarding your post-operative symptoms. Based on your description, it seems that you are experiencing a range of symptoms, including pain in the right nasal wing, swelling in the neck and jaw area, and some discomfort during swallowing. Let's break down your concerns and provide some insights.

1. Post-Operative Symptoms: It is not uncommon to experience discomfort, swelling, and even some referred pain after dental extractions, especially when the procedure involves a tooth that has undergone previous treatments like root canal therapy. The pressure and pain you felt during the procedure could be attributed to the manipulation of the surrounding tissues, which can lead to temporary inflammation and discomfort. The sensation of pressure in your nasal cavity and ears may be related to the proximity of the tooth roots to the maxillary sinus, which can sometimes be affected during extraction.

2. Temperature and Pain Management: A mild fever (37.6°C) can occur post-surgery due to inflammation, but it is essential to monitor this closely. If your temperature rises significantly or persists, it may indicate an infection. The pain radiating to your neck and shoulders could be due to muscle tension from discomfort or inflammation in the jaw area. It's good that you are taking anti-inflammatory and pain medications as prescribed, and if these are providing relief, that is a positive sign.

3. Nasal Symptoms: The dried blood in your right nostril and the sensation of pressure could suggest that there might be some bleeding that has tracked into the sinus area or nasal cavity. If you experience any unusual discharge or a foul smell from your nose, it would be prudent to seek medical attention, as this could indicate a possible complication.

4. Follow-Up Care: The advice from the dental staff to wait a week to see if symptoms improve is reasonable, but you should not hesitate to seek further evaluation if your symptoms worsen or do not improve. If the pain becomes unbearable or if you notice any signs of infection (such as increased swelling, redness, or discharge), you should return to your dentist or seek care from an ear, nose, and throat (ENT) specialist as suggested.

5. Medication: It is crucial to complete the prescribed course of antibiotics and pain medications unless directed otherwise by your healthcare provider. Stopping medication prematurely can lead to complications, especially if there is an underlying infection.

In summary, while some discomfort and symptoms are expected after such a procedure, it is essential to remain vigilant for any signs of complications. If your symptoms persist or worsen, do not hesitate to seek further medical advice. Your health and comfort are paramount, and timely intervention can prevent more serious issues from developing.

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